Ischemic Stroke after Therapeutic Plasma Exchange in a Patient with Guillain–Barré Syndrome: A Case Report

Abstract

Background: Therapeutic plasma exchange is an established treatment for Guillain–Barré syndrome (GBS). An ischemic stroke developing after treatment presents an important diagnostic problem, but temporal association does not establish a procedural cause. Case Presentation: A 71-year-old man with hypertension developed rapidly progressive, symmetrical ascending weakness, areflexia and severe tetraparesis. Cerebrospinal fluid and nerve-conduction findings supported acute inflammatory demyelinating polyneuropathy. Because intravenous immunoglobulin was unavailable, he received five plasma-exchange sessions and improved from 0/5 power in all limbs to 4+/5 in the upper limbs and 3/5 in the lower limbs. Two days after discharge, he developed abrupt right-sided hemiparesis and dysarthria. Non-contrast brain computed tomography was reported to show an acute left middle cerebral artery territory infarct. Electrocardiography, echocardiography, carotid ultrasonography and reported angiographic assessment did not reveal an obvious major embolic or large-vessel source. He received antiplatelet and statin therapy with hydration and supportive care. Discussion: The interval between the final exchange and stroke onset was not documented precisely. Advanced age and hypertension were independent vascular risk factors. Hemodynamic and hemostatic effects of plasma exchange offer possible, but unverified, contributing mechanisms; procedural monitoring data and post-stroke functional follow-up were not available in the case description. Conclusion: An ischemic stroke occurred after a course of plasma exchange for GBS, without evidence sufficient to attribute causation to the procedure. New focal neurological symptoms following treatment warrant immediate stroke assessment and investigation of conventional stroke mechanisms.